Active NPI
John Melton Bennett, MD, MPH
- Family Medicine Physician
- Berea, KY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 30690
- Practice address
- 209 Pauline Dr
Berea, KY 40403-8889 - Phone
- (859) 233-4511
- NPI assigned
- Jun 26, 2006
- Last updated
- Apr 3, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 30690 | KY | |
| Family Medicine Physician | 207Q00000X | 30690 | KY | Primary |
| Adolescent Medicine (Family Medicine) Physician | 207QA0000X | 30690 | KY | |
| Adult Medicine Physician | 207QA0505X | 30690 | KY | |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 30690 | KY |
Addresses
Primary practice location
209 Pauline Dr
Berea, KY 40403-8889
Mailing address
1101 Veterans Dr
Berea Cboc
Lexington, KY 40502-2235
Phone (859) 233-4511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64306905 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeastern Emergency Physicians LLC | Emergency Medicine | Current | Accepting new patients |
Locations
1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521
1140 Lexington Rd
Ste 203
Georgetown, KY 40324
Phone (502) 570-3757
60 Mercy Ct
Irvine, KY 40336
Phone (606) 723-2115
310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612
360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Maysville, KY
- NPI 1356379382
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428019200000",
"number": "1851328074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 VETERANS DR",
"address_2": "BEREA CBOC",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405022235",
"telephone_number": "859-233-4511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "209 PAULINE DR",
"city": "BEREA",
"state": "KY",
"postal_code": "404038889",
"telephone_number": "859-233-4511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "JOHN",
"middle_name": "MELTON",
"credential": "MD, MPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-26",
"last_updated": "2015-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "KY",
"license": "30690",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "KY",
"license": "30690",
"primary": true
},
{
"code": "207QA0000X",
"taxonomy_group": "",
"desc": "Family Medicine, Adolescent Medicine",
"state": "KY",
"license": "30690",
"primary": false
},
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "KY",
"license": "30690",
"primary": false
},
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "KY",
"license": "30690",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64306905",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Berea, KY
- Kristy Batchelder, CSA
- Robin G Beaver
- Rita Deattrea Beckford, M.D.
- Beh Physical Therapy
- Hannah Bennett, MD
- Berea Area Development LLC (The Terrace Nursing and Rehabilitation Facility)
- Berea Clinic of Internal Medicine, PSC
- Berea College Health Service
- Berea Drug Co Inc
- Berea Drug Co Inc (Berea Drug)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.